Last session, the Legislature did not expand Medicaid as called for under the Affordable Care Act. Although there seemed to be enough bipartisan support, the Governor made it clear that he would veto anything related to Medicaid expansion.

However, even despite the state leadership’s efforts to stymie enrollment, about 700,000 Texans signed up for insurance through the health care exchange.

But because only those who earn between 100 percent and 400 percent of the federal poverty level qualified for health insurance subsidies, and there was no Medicaid expansion in Texas, the working poor – those under 100 percent of the federal poverty level, which is $24,000 a year for a family of four or less than $12,000 for a single person – were left without an alternative.

It’s estimated that about 1.3 million Texans don’t have any avenue to access health care other than through an emergency room.

In El Paso, prior to the opening of the marketplace, we had about 176,000 uninsured. Only about 26,000 qualified for the subsidies to buy plans in the marketplace, thereby leaving 150,000 without an affordable health insurance option.

So how do we close this coverage gap?

Although it continues to be politically challenging, we must keep pressing for a “Texas solution” to this coverage gap.

We should keep the following principles in mind when crafting a Texas solution:

Make sure coverage is equally available statewide;

Support health coverage and health homes for all family members;

Offer comprehensive benefits that are at least as good as commercial and small business standards;

Consider including personal responsibility provisions such as:

affordable cost-sharing (e.g., co-payments, premiums for adults above the poverty line) that is not punitive to family members with serious or chronic illness; and

incentives for wellness behaviors that are evidence-based and not punitive to persons who are ill;

Include reasonable policies to ensure ongoing access to community safety net providers; and